Noppen M, Piérard D, Meysman M, Claes I, Vincken W
Respiratory Division and Microbiology Department, Academic Hospital AZ-VUB, Free University of Brussels, Brussels, Belgium.
Am J Respir Crit Care Med. 1999 Aug;160(2):672-7. doi: 10.1164/ajrccm.160.2.9812081.
Airway stenting (AS) is increasingly used in the management of obstructive lesions of the central airways. Although retention of secretions and infection have been reported as complications of AS, the microbiological consequences of AS have not yet been evaluated. In this study, we prospectively performed protected specimen brush (PSB) sampling of the airways, before and 3 to 4 wk after AS, in 14 consecutive patients (65 +/- 17 yr), suffering from bronchial (5), extensive esophageal (2), thyroid (1), and adenocystic (1) carcinoma, stenotic tracheal burn lesions (2), postintubation stenosis (2), and Wegener's granulomatosis (1). A cutoff value of >/= 10(2) colony-forming units (cfu). ml(-)(1) was considered diagnostic for airway colonization (AC). PSB results were related to the presence and degree of secretion retention (SR) at the level of the stent. In five of the 14 patients, AC was present prior to AS; in three of these, potentially pathogenic microorganisms (PPM) were identified. After AS, AC was found in 11 (including seven patients without prior AC) of the 14 patients. In six of these patients, one or more PPM were present (Pseudomonas aeruginosa [4], Staphylococcus aureus [3], Streptococcus pneumoniae [1], Klebsiella spp. [1]). Although AC tended to be associated with the presence of SR (PSB >/= 10(2) cfu. ml(-)(1) in 10 of 12 SR-positive and in zero SR-negative cases; PSB < 10(2) cfu. ml(-)(1) in two SR-positive and in two SR-negative cases), statistical significance was not reached (Fisher exact test, p = 0.06). We conclude that AS is frequently followed by AC, the majority of which occurs in patients without AC prior to AS, and is caused by PPM. In no case, however, AC was associated with clinical signs of infection. AC tended to be associated with SR in the stent.
气道支架置入术（AS）在中央气道阻塞性病变的治疗中应用越来越广泛。尽管已有报道称分泌物潴留和感染是AS的并发症，但AS对微生物学的影响尚未得到评估。在本研究中，我们对14例连续患者（年龄65±17岁）进行了前瞻性研究，在AS术前及术后3至4周，通过保护性标本刷（PSB）对气道进行采样，这些患者分别患有支气管癌（5例）、广泛性食管癌（2例）、甲状腺癌（1例）、腺囊癌（1例）、气管烧伤狭窄性病变（2例）、插管后狭窄（2例）和韦格纳肉芽肿（1例）。菌落形成单位（cfu）≥10²/ml被认为是气道定植（AC）的诊断标准。PSB结果与支架部位分泌物潴留（SR）的存在及程度相关。14例患者中有5例在AS术前即存在AC；其中3例鉴定出潜在致病微生物（PPM）。AS术后，14例患者中有11例（包括7例术前无AC的患者）发现有AC。这些患者中有6例存在一种或多种PPM（铜绿假单胞菌[4例]、金黄色葡萄球菌[3例]、肺炎链球菌[1例]、克雷伯菌属[1例]）。尽管AC往往与SR的存在有关（12例SR阳性病例中有10例PSB≥10² cfu/ml，SR阴性病例中无一例；2例SR阳性病例和2例SR阴性病例中PSB<10² cfu/ml），但未达到统计学意义（Fisher精确检验，p = 0.06）。我们得出结论，AS术后常发生AC，其中大多数发生在术前无AC的患者中，且由PPM引起。然而，在任何情况下，AC均与感染的临床症状无关。AC往往与支架内的SR有关。
